Flexible optical surgical instrument

ABSTRACT

993,324. Endoscopes. AMERICAN CYSTOSCOPE MAKERS Inc. April 4, 1962 [April 14, 1961], No. 12925/62. Heading A5R. [Also in Division G2] A flexible endoscope for intestinal examination comprises elongated flexible means 12 including an elongated bundle 28 or 104 of a very large number of extremely fine lightconducting fibres mutually oriented at the ends 20 that an image presented by means 13 or 102 to the end face 32 or 108 is conducted to the end face 31 to be viewed through the eyepiece assembly 11 and a member 78 mounted externally of the means 13 or 102 can be inflated by way of means extending along the means 12. The air for inflation may pass along a tube 75 or just through the spaces around the bundle. The means 12 consists of from one to three stainless steel spirals 44, or alternatively a polyvinylchloride tube, from five to six feet in length and covered with a resilient sheath 79. The spirals or tube are fastened at their distal end to a connector 35 and at their proximal end to a sleeve 26. The sleeve 26 is joined by a collar 22 to a body 15 in which the fibrebundle endface 31 is held at 29 and in which the eyepiece 11 with its lenses 33 screws telescopically. The connector 35 holds the fibre-bundle end-face 32 at 34 (Fig. 2) and is connected flexibly by a metallic spring 45 to a tube 47 which carries a panoramic lens 49 and a lamp 61 surrounded by a fuzed quartz window 62 to illuminate the inside of the large intestine or other surface to be examined. Electrical connections for the lamp are provided through an axial spring 57 and an insulated wire 64 which connect with a source at the proximal end by way of split rings 38 insulated at 40. The annular image from the lens 48 is received by lenses 52 and 53 and focused on to the end face 32 of the bundle 28. Fig. 7 shows the distal end of an alternative embodiment with a lens 113 giving forward vision along the interior of the large intestine. The lamp is omitted and illumination is provided through an annular ring 106 of light-conducting fibres which surrounds the image-conducting bundle 104 and has its end-face 107 in contact with a glass cylinder 115 silvered inside and out which transmits the light around the lens system 112. This latter embodiment has a proximal end similar to that shown in Fig. 3 except that the annular fibres 106 are gathered into a single bundle and brought out through the side of the collar 22 to receive light from an external source. Specifications 993,322 and 993,323 are referred to.

Aug. 13, 1963 .1. HETT FLEXIBLE OPTICAL SURGICAL INSTRUMENT m *0 mm m m?hm 9mm 3 Sheets-Sheet 1 2. 3m mv 6 in Q on vv m 2 1 2 4 1 ll F 1 1 w A 3w w NE 9 2 m. E 5 n a F Aug. 13, 1963 J. H. HETT FLEXIBLE OPTICALSURGICAL INSTRUMENT 3 Sheets-Sheet 2 Filed April 14, 1961 Aug. 13, 1963J. H. HETT FLEXIBLE OPTICAL SURGICAL INSTRUMENT 3 Sheets-Sheet 5 FiledApril 14, 1961 Has ite

Patented Aug. 13, 1963 ice This invention relates to a flexible opticalinstrument and more particularly to a flexible surgical instrumentespecially well suited for complete visualization of the large intestinefrom the rectum to the caecum, without the performance of surgicalprocedures involving the cutting of an opening into the body of thepatient. Instruments have long been desired which could be inserted intoan opening in the body of a patient without the need for performing anysurgery and which would permit precise visualization and diagnosis ofhitherto inaccessible areas and organs within the patients body. In myco-pending patent application," Serial No. 85,040, filed January 26, 1961, assigned to the assignee of my present application and of which bypresent application is a continuation-in-part, there is set forth aflexible optical instrument which is particularly adapted for use invisualizing the ureter and portions of the kidney. While access to thelarge intestine is more readily attainable than in the case of theureter and the kidney, the peristaltic motion of the intestine creates aspecial problem when visualization of the interior of the intestine isattempted. Furthermore, the sharp curvature at both the left and rightcolic flexures require an instrument having a great degree offlexibility over a working length of about five and one half feet.

It is, therefore, a principal object of this invention to provide acompact, highly flexible surgical optical instrument by means ofwhichthe inner surface of the large intestine may be visualized from endto end thereof, the image provided being characterized by a high degreeof brightness and good definition.

A further object is to provide such an mstrument in ductor which is madeup of a very large number of extremely small diameter, light conducting,flexible fibers. In another embodiment of the present invention, inaddition to the flexible image conductor, a flexible light conductor isprovided for carrying the light from a remote, high intensity lightsource, along the interior of the instrument to illuminate the areaviewed through the elongated flexible image conductor.

The foregoing as well as additional objects and advantagesof the presentinvention will beapparent from the following description of preferredembodiments of the present invention and the accompanying drawings inFIGURE 1 is an elevational veiw of an instrument constructed inaccordance with the presentinvention; FIGURE 2 is a cross sectional viewon an enlarged scale taken through the line 2--2 of FIGURE 1;

FIGURE 3 is a cross sectional view, also on an enlarged scale takenthrough the line 33 of FIGURE 1; FIGURE 4 is a sectional view takenthrough the line 44 of FIGURE 3; g

FIGURE 5 is. a sectional view taken along the line 5-5 of FIGURE 2 inthe direction indicated; and

FIGURES 6 and 7 are views, similar to FIGURES '1- and 2 respectively ofanother embodiment of the present 3 invention.

which the distal viewing end is flexibly joined to a'remote eyepieceassembly and is readily maintained centered in the intestine and is notdislodged by the peristaltic motion of the intestine.

Yet another object of the present invention is to provide such aninstrument by means of which an image of an entire annular segment ofthe intestine, throughout 360 thereof, is presented to the viewer.

Another object of the present invention is to provide such an instrumentin which the viewing head at the distal end of the instrument ismaintained in position in the intestine in spite of its peristalticmotion and by which illumination and visualization of an area forward ofthe viewing head is provided.

In accordance with one feature of the present invention, an inflatablebag is provided on the viewing head ofrthe instrument by means of whichthe viewing head may be maintained positioned with the objective lenscentered in the intestine. 1

In one embodiment of the present invention, a pano ramic lens isprovided which affords a View throughout 360 of the interior of asection of the intestine. The

image formed by t'ne panoramic lensis carried by an.

image carrier in the form of an elonagted flexible image conductor whichmay be several feet in length and which, optically interconnects theviewing head at the distal end Instruments constructed in accordancewith the present invention may be successfully utilized to traverse andvisualize the entire interior of the large liutestine For the purpose ofexemplifying the present invention, it will now be described inconnection with instruments constructed for the purpose of visualizingthe large intestine over its entire length in the body of a humanpatient. However, it is to be noted that instruments constructed inaccordance with the present invention are useful for, among otherthings, examining other remote portions of the human body. p

Referring now to the drawing in detail, flexible sungical instrument 10comprises an eyepiece assembly 11 joined to one end, the proximal end ofan elongated flexible tubular assembly 12 which in turn terminates inand is joined to an objective or head assembly indicated genera ally at13.

As is most clearlyshown inlFIGURE 3, eyepiece as-:

sembly 11 comprises a generally tubular body member 15 having anexternally threaded portion 16iof reduced diameter at its proximal end.An eyepiece rotor 18, having an internally threaded portion 19* engagingthe threaded portion 17, extend in telescoping relation over the bodymember 15; an O-ring 20 seated in an annular recess formed in the rotor18 adjacent to its distal end providing a sliding seal with the outersurface of the body member 15. An eyepiece 21 is fitted to the end ofthe rotor 18 for axial movement therewith'when the rotor is rotatedrelative to the body member 15.

An internally threaded collar 22, having. a pair of tapped openings '23and 24 formed therethrough for a purpose yet to be described, serves toconnect the threaded distal end of the body member 15 to the proximalend of a-rotary contact support member 25 which terminates at its distalend in a sleeve 26 of reduced diameter. 1

An elongated optical fiber bundle 28 enclosed in thin walled flexiblesheath preferably formed of latex, extends through the support member25. At its proximal end, the flbe-r bundle 28 is fitted with a collar 29and set screws 30 serve to anchor centrallythis end of the fiber bundlewithin the body member 15.

Optical fiber bundle 28 functions in the present em bodiment as an imageconductor and for this purpose is made up of a large number of extremelysmall diameter light conducting fibers tightly packed together to form agenerally cylindrical array approximately one quarter of an inch indiameter. The image conductor 28 may be manufactured as described'in theco-pending application No. 76,868. As thus manufactured, the imageconductor 28 comprises an extremely large number, 75,000 to viewed by 'asuitable magnifying lens system represented by, the lenses 33'mount'edin the eyepiece rotor 18.

At its distal end,the image conducting bundle 28- is fitted with acollar 34 and secured centrally within a connector 35. Preferablyconnector 35 is: formed of an insulative material such as Teflon andserves to interconnect thevarious parts forming the flexible tubularassembly 12 and the objective or head assembly 13.

" Connector 35, as shown most clearly inv FIGURE 2,

Y is generally in the form of an annular disc having a portion 36 ofreduced diameter projecting therefrom, the connector 35'being [formedwith a central axially extending passageway}? extending therethrough inwhich the distal end of the image conductor 28' is clamped as has beendescribed The connector portion 36 is externally threaded to receivee.contact assembly comprising a split contact ring, the t;w o halves ofwhich are designated 'as 38a and 38 and are spaced and insulatedzfromeach other by means'of insulators 39' (FIGURE 5). An insulating ring 40which is generally L-shapedincross section is seated against the splitcontact ring members 38a, 33b and is in turn enclosed about itsperiphery by annular junction ring member 41 which is locked to andconductively connected with contact tmember 38a by means of a conductivepin; 42 which extends thnough the intermediate portion of theinsulatorring 40.

The elongated flexible tubular assembly'12, may be approximately five tosix fleet or more in length and may be so flexible as to requirerigidification inorder to facilitate insertion and manipulation withinthe body of a patient; In the embodiment now being described, flexibleassembly 12 incorporates three flexible spiral members 44, formed ofstainless ste'elo'r' other suitable material, along the vcommon axis ofwhich the image conducting bundle 28' extends. At one end thereof, thespiral members 44- are anchored to the connector 35 by pin 43 While attheir opposite ends the spirals are connected to-the support sleeve 26.In the present instance the three spiral members 44 extend one withinthe other, the outermost member 44 having somewhat greater thicknessthan the inner two, and with the opposite ends of the members 44 securedtogether andanchored they are capable of transmitting substantial torquewithout impairing thedesired degree of flexibility While three spiralmembers have been described and shown in FIGURE 3 only one such member Imay be satisfactorily used in some instances. Furtherm-ore the desireddegree of'rigidification while preserving the overall flexibility of theinstrument may also be attained bymeans of other instrumentalities suchas a flexible thin Walled tube formed of polyvinyl chloride which may beused to enclose the image conductor 28 as lar support member 47. Apanoramic lens 48' is cemented to the distal end of the tubular supportmember 47 with the latter-engaging only the peripheral portion of thelens.

of Lawrence E. Curtiss, filed on December19, 1960, Serial i 'As ismostclearly shown in FIGURES l and 2, the in focused ion the end face 32of the image conducting bundle 28. Lenses 52 and 53 are supported withina lens housing 54 carried in a sleeve 55 which is in turn mounted withinthe spring 45. 7

Spider 56 is positioned in the forwardly presented or V distal end ofthe lens housing 54 and has a central support ring 56a to which one endof an electrical conductor in the form of an elongated spirally woundspring 57 is con- 7 nected. The other endof the spring 57 is connectedto a sleeve 58 formed of brass or other suitable conductive material andwhich is in turn connected to a portion of the socket of a lamp housing59 which extendsthrough the panoramic lens aperture 51. Lamp housing 59comprises a cap 60 the internal surface of which functions in part as areflector for light from a lamp 61 which passes out through the clearfused quartz circular window 62 of the housing. The lamp '61 isthreadedinto the socket of the housing 59 and has a central contactwhich engages spring biased contact member 63 which in turn isconductively connected to an insulated wire '64., As is most clearly larcontact member 70 insulatively supported on the support member 25. i 1The ground return path for current supplied to the lamp 61 is throughthe spring 57, an insulated wire conductor 71 and the'second contactmember 67 (not shown) supported by theconnector "35 and to whichinsulated jwire73 is connected. Wire 73 may be connected directly toannular contact surface 72 or the connection maybe completed through thespiral members 44. i

A flexible tubular conduit 75 formed of latex or other suitable materialextends within the'spirals 44 throughout the entire length of theflexible assembly 12. As

shown in FIGURE 3, the, proximal end of tube75'communicates through theopening '23 formed in collar 22 with a stop-cock fitting76 or othersuitable device adapted for connection to agsource ofair under pressure.The distal'endof the tube 75 is connected to the connector member 35 andcommunicates through a passageway 77 formed in the latter with theinterior of an annular inflatable member 78.

flatable member 78 encloses the spring member45 so as to trap the airwithin the head assembly '13; All but that portion of the member'78whichit is desired to be inflated is covered by the distal end portionof an external resilient sheath 79 which also serves to enclose tubularassembly 12. Thus, air forced into the instrument along of theinfiatablemember 7% which is not enclosed by the external sheath79'becomes distended to form an enlarged V annular shape as shown inFIGURE 2.

The instrument 10 is readily manipulated in use because of, among otherthings, its extreme flexibility and its compact construction. Thoseparts of the head asr sembly which are rigid are short in length, aboutone inch, and the largest diameter of the head end of the instrulengthto straighten out the curves of the pelvic and ileac colons; a sealingmember, inthe form of a centrally apertured resilient member mounted inthe mouth of the proctoscop'e, providing a sliding seal with theinstrument so, as to prevent escape of an inflating medium, such as airor water, which is introduced into the intestine through theproctoscope. With the-member 7 8 inflated the panoramic lens 48 iscentered in theinflated intestine and the peristaltic motion iscompensated for. The 360 andap proximately 30 wide Zone of view of thelens 48 together with the high degree of flexibilityof thepinstrumentmakes possible complete visualization of the entire interior of thelarge intestine. The spring 45 which serves to interconnect the rigidportions of the viewing head assembly 13 with connector 35 makes itpossible for the instrument to negotiate the very sharp bends of theright andleft colic flexures. Furthermore, this is achieved with aminimum amount of manipulation of the instrument thereby minimizing theamount of discomfort that may be experienced by the patient. i 1

Turning now to FIGURES 6 and 7 of the drawing, surgical instrument 100is a further embodiment of the present invention constructed so as to beespecially well suited for affording forward vision along the interiorof the large intestine and comprising an eyepiece assembly 101 joined toan objective or head assembly 102 by a flexible tubular assembly 103which may be five to six feet or more in length.

Eyepiece assembly 101 is generally somewhat similar in construction toeyepiece assembly 11 shown in FIG- URE 3 and in order to avoidunnecessary repetition those parts of eyepiece assembly 101 which aresimilar to corresponding parts of eyepiece assembly. 11 are designatedin FIGURE 6 with the same reference character used in FIGURE 3. i

The rigiditied proximal end of an image conductor section 104 iscentrally anchored in the body member as was described in connectionwith the optical fiber bundle 28. The image conductor section 104comprises the centrally extending portion of a composite light and imagecarrier 105 which may be manufactured as described in said Curtissco-pending application Serial No. 76,868. The light carrier section 106of the light and image carrier 105 surrounds the major portion of theimageconductor section 104. As shown most clearly in. FIGURE 6, theoptical fibers of the light carrier section 106 are separated from theimage section 104 within the eyepiece assembly 101 and are formed as agenerally rigid rod like extension 106a extending at'an angle to theimage conductor, section 104 and out through an opening formed 7 in thewall of the member .22. The external end of the 6 carrier section beingspread somewhat. The objective lens holder 109 supports a pair ofspacedlenses 111, 112 mounted to receive an image through the outergenerally spherical lens 113 and focus it on the end face 108 of theimage carrier.

Lens 113 is mounted in and closes the end of a tubular member 114 inwhich the distal end of the light and image carrier 105 is received andin which thelens' holder 109 is axially positioned. Mountedbetween themember 114 and the objective lens holder 109 is a glass cylinder 115having one annular end face 116 in face-to-face contact with the lightcarrier end face. The opposite end face 117 of the glass cylinder 115extends substantially in the same plane as the outer end of the lensholder .109 and is presented to the lens 113 for illuminating the fieldunder view through the lens 113 with light received from the lightcarrier 106. To minimize light loss through the glass cylinder 1 15,'itsinner and outer cylindrical surfaces are coated as indicated at 118 witha highly reflective coating of silver or the like. In operation lightentering light carriersection 106a after traveling the length of thefibers forming the light carrier 106, passes into and through the glasscylinder 115 to illuminate the area viewed through the outer lens 113.An image of the illuminated field is focused on the end face 108 of theimage carrier and is conducted bythe fibers of the image carrier to theproximal end face thereof in the eyepiece assembly 101 where it isviewed through the magnifying and focusing lenses of the eyepieceassembly. i

The tubular member 114 is secured to the distal end of a sleeve 119 towhich the distal ends of the spiral members 44 are connected. An annularinflatable bag 120 is mounted on and extends about the member 114 andhas its interior in communication with one or more channels 121 formedin the wall of the member 114. An air tube 75 may be. used tointerconnect the channel 121 with the stopcock fitting 76 whereby thebag 120 may be inflated as was described in connection with theinflatable member 78 shown in FIGURE 2. In practice, the interior of theinstrument is sealed air tight by an external sheath and the tube 75 maybe omitted, the inflating medium introduced through fitting 7 6freelypassing along the, length of the instrument to the inflatable bag 120.Inflation of the bag 120 rather than the external sheath is assured byforming the bag 120 of thinner or less rigid material than the sheath.

.Aswas described in connection with FIGURES 1-3, an external sheath 125made of thin walled latex tubing or other suitable material is utilizedto enclose the tubular assembly .103. The spiral members 44 may bedispensed with when the external sheath 125 is formed of suflicientlythe formof. a catheter incorporating one or more channels extension 106ais fitted with a female Luer lock connector and itsend face is opticallypolished to provide for the elficient entryof light into the fibersforming thelight.

carrier from a flexible light source similar to that shown and describedin my saidco-pending application-Serial,

No. 85,040. The fibers forming the light carrier section 106extend'from-end to end thereof 'a s-in thejcase of the: image conductorsection 104 and through'the length of the flexible tubular, assembly 103into the head assembly 102 where the fibers of the light carriersection106 terminate flush with the fibers .of the image conductorsection 104. Thus, the light carrier section 106 terminates in anannular end face 107 which surrounds and extends the same plane as theend face 108 of the image carrier.

An objective lens holder 109 is formed with a portion V of reducedthickness at one end thereof which may be tapered to form a feather edgeand which is inserted bea tween the adjacent end portions of the lightcarrier and image conductor sections, the end portion of thelight nelextending in the wall thereof between its opposite ends.

One of such channels may communicatewith the interior of an annularinflatable'bag 'formed on the sheath adjacent to the-distal end of thehead'assemblywhileanother chant may communicate through an openingdirectly with the interior of the intestine.

The terms and expressionsWhich haye been employed are used-as terms'ofdescription and not'of limitation, and j there is no intention,.intheuse of such terms and 'expres sions ofexcluding'anyequivalents of thefeatures shown and described or portions thereof, but is recognized thatvarious modificationsare possible within the scope of the inventionclaimed. Iclaimfl r i '1 1. A flexible optical instrument particularlyfor insertion into and for, examining the entire interior of the largeintestine in the body of a patient, comprising elongated flexible meansincluding an elongated flexible bundle Cf a very large number ofextremely fine light conducting fibers mutually oriented atthe oppositeend faces of said bundle so that an image presented to the distal end ofsaid bundle is conductedto the proximal end face thereof, resilientmeans connected adjacent one end thereof to the V distal end of saidflexible means 'and adapted to pass the left and right colic flexures, apanoramic lens connected tothe distallend of said resilient means, saidpanoramic lens having an axially extending opening formed therethronghand an annular end face presented toward the distal end of said bundlefor providing an image of a 360 fieldsurrounding said panoramic lens,objectivele'ns means, and objective lens holder supporting saidobjective lens means Within said resilient means intermediate saidpanoramic lens annular end face and the distal end of said bundle, meansincluding a lamp mounted on the distal side of said panoramic lens forilluminating the 360 field around said panoramic lens, means extendingaxially through the hole'in said panoramic lens and connected to saidobjectivelens holder including a resilient member for anchoring saidiluminating means, an annular expansible member surrounding saidresilient meansfmeans extending along said flexible meansandcomrnunicatingwith said expansible member for inflating the latter, andmeans 1 connected to the proximal end of said flexible means for viewingan image of said field on the proximal end of said bundle. i

2. A flexible optical instrument particularly for insertion into andvfor examining the entire interior of the large intestine in the body ofa patient, comprising elongated fiexible means including an elongatedflexible bundle, of a verylarge number of extremely fine lightconducting fibers mutually oriented at the opposite end faces of saidbundle so that an image presented to the distal end of said bundle isconducted, to the proximal end face thereof, objective lens meansincluding an objectivelens and a panoramic lens for focusing an imagethroughout 360 oi anannular field on the distal end face of. saidbundle, means including a lamp mounted on the distal side of saidpanoramic lens for illuminating a 360 field presented, to said panoramiclens, elongated resilient means, connected atone end thereof to the,

distal end of" saidflexible means andv connected at its opposite, end'vto said panoramic lens, said elongated resilient means being adaptedtopass the left and right colic flexures; inflatable means surroundingsaid resilient means, means supporting said objective lens within saidresilient 'means inter-mediate said panoramic lens and the distal end ofsaid bundle, means extending along said flexible means andcommunicatingwith said inflatable means for inflating the latter, andmeans connected to the flexible means for viewing an image of said fieldon the proximal end of said bundle.

3. A flexible optical instrument particularly for insertion into and forexamining th-eentire interior of the large intestine in the body of apatient, comprising elon gated flexible means including an elongatedflexible bundle of a very large number of extremely fine lightconducting fibers mutually oriented at the opposite end .faces of saidbundle so that van image presented to the distal end of said bundle isconducted to the proximal end face thereof, objectivele'nsmeansincludinga lens means and an objective lens for forming an image-of a fieldand-focusing-th-e same on the distal end face of said bundle, meansincluding a lamp mounted on the I distal side of said lens means 4501'illuminating the field presented to said lens means, elongated resilientmeans connected at one end thereof to the distal end of said flexiblemeans and connected at its opposite end to said lens means, saidelongated resilient means being adapted to pass the left and right colicflexures, inflatable means surrounding, said resilient means, meanssupporting said objective lens within said resilientsmeans intermediatesaid lens means and the distal end of said bundle, meansextending alongsaid flexible means and communicating with said inflatable, means forinflating the latter, and means connected to the flexible means forviewing an image of said field on the proximal end of said bundle.

References Cited in the file of this patent UNITED STATES PATENTS2,959,089 Hett Nov. 8, 1960 2,975,785 Sheldon -Ma r. 21, 196 1 v FOREIGNPATENTS 526,643 Germany June 8, 1931 129,955 Austria Oct. 25, 1932 H593,213 Great Britain Oct. 10, 1947 1,059,615 Germany June 18, 1959OTHER REFERENCES Kapany article in the Strong Book, Concept of ClassicalOptics, 1958, pages 565-567, published by W. H. Freeman & Co. (Copy inDiv. 7.) e

3. A FLEXIBLE OPTICAL INSTRUMENT PARTICULARLY FOR INSERTION INTO AND FOREXAMINING THE ENTIRE INTERIOR OF THE LARGE INTESTINE IN THE BODY OF APATIENT, COMPRISING ELONGATED FLEXIBLE MEANS INCLUDING AN ELONGATEDFLEXIBLE BUNDLE OF A VERY LARGE NUMBER OF EXTREMELY FINE LIGHTCONDUCTING FIBERS MUTUALLY ORIENTED AT THE OPPOSITE END FACES OF SAIDBUNDLE SO THAT AN IMAGE PRESENTED TO THE DISTAL END OF SAID BUNDLE ISCONDUCTED TO THE PROXIMAL END FACE THEREOF, OBJECTIVE LENS MEANSINCLUDING A LENS MEANS AND AN OBJECTIVE LENS FOR FORMING AN IMAGE OF AFIELD AND FOCUSING THE SAME ON THE DISTAL END FACE OF SAID BUNDLE, MEANSINCLUDING A LAMP MOUNTED ON THE DISTAL SIDE OF SAID LENS MEANS FORILLUMINATING THE FIELD PRESENTED TO SAID LENS MEANS, ELONGATED RESILIENTMEANS CONNECTED AT ONE END THEREOF TO THE DISTAL END OF SAID FLEXIBLEMEANS AND CONNECTED AT ITS OPPOSITE END TO SAID LENS MEANS, SAIDELONGATED RESILIENT MEANS BEING ADAPTED TO PASS THE LEFT AND RIGHT COLICFLEXURES, INFLATABLE MEANS SURROUNDING SAID RESILIENT MEANS, MEANSSUPPORTING SAID OBJECTIVE LENS WITHIN SAID RESILIENT MEANS INTERMEDIATESAID LENS MEANS AND THE DISTAL END OF SAID BUNDLE, MEANS EXTENDING ALONGSAID FLEXIBLE MEANS AND COMMUNICATING WITH SAID INFLATABLE MEANS FORINFLATING THE LATTER, AND MEANS CONNECTED TO THE FLEXIBLE MEANS FORVIEWING AN IMAGE OF SAID FIELD ON THE PROXIMAL END OF SAID BUNDLE.